Doctor Name: | ANDREA JONELLE DORTCH-HENRY |
NPI Number: | 1134399579 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHARMD |
License Number: | PS35006 |
Business Practice Address: | 16555 Nw 25th Ave Opa Locka, FL - 330546583 |
Business Phone Number: | 7864661735 |
Business Fax Number: | |
Mailing Address: | 12425 Sw 7th Pl, DAVIE |
State: | FL |
Postal Code: | 333253439 |
Phone Number: | 9542900974 |
Fax Number: | |
NPI Enumeration Date: | 02/29/2008 |
NPI Last Update Date: | 02/29/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261Q00000X |
License Number: | PS35006 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |